In this Jan. 25, 2017 photo, face transplant recipient Andy Sandness looks over the Saint Marys Hospital campus at the Mayo Clinic in Rochester, Minn. Sandness, the first to receive a face transplant at the medical center, has the nose, cheeks, mouth, lips, jaw and chin of his donor, Calen "Rudy" Ross. (AP Photo/Charlie Neibergall) less

In this Jan. 25, 2017 photo, face transplant recipient Andy Sandness looks over the Saint Marys Hospital campus at the Mayo Clinic in Rochester, Minn. Sandness, the first to receive a face transplant at the ... more

Photo: Charlie Neibergall, STF

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In this June 10, 2016 photo provided by the Mayo Clinic, Andy Sandness waits for his face transplant procedure at the Mayo Clinic in Rochester, Minn. Asked by the doctors what he expected from the transplant to make sure he had realistic goals, Sandness said he wanted a working nose, the ability to bite, swallow, chew _ and to "get good stares as opposed to bad stares." (Eric M. Sheahan/Mayo Clinic via AP) less

In this June 10, 2016 photo provided by the Mayo Clinic, Andy Sandness waits for his face transplant procedure at the Mayo Clinic in Rochester, Minn. Asked by the doctors what he expected from the transplant to ... more

Photo: Eric M. Sheahan, HONS

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In this June 10, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini shows Andy Sandness photos of his children on his smartphone before Sandness' face transplant surgery in Rochester, Minn. Over the years, the two say they've become as close as brothers. (Eric M. Sheahan/Mayo Clinic via AP) less

In this June 10, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini shows Andy Sandness photos of his children on his smartphone before Sandness' face transplant surgery in Rochester, Minn. Over the ... more

Photo: Eric M. Sheahan, HONS

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In this June 10, 2016 photo provided by the Mayo Clinic, a medical team of about 60 doctors, nurses, anesthesiologists and others at Mayo Clinic gather before performing the first face transplant surgery at their hospital in Rochester, Minn. Mardini and his team devoted more than 50 Saturdays over 3 1/2 years to rehearsing the procedure, using sets of cadaver heads to transplant the face of one to another. They used 3D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on Andy Sandness. (Michael Cleary/Mayo Clinic via AP) less

In this June 10, 2016 photo provided by the Mayo Clinic, a medical team of about 60 doctors, nurses, anesthesiologists and others at Mayo Clinic gather before performing the first face transplant surgery at ... more

Photo: Michael Cleary, HONS

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In this June 11, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. The surgery that started shortly before midnight Friday was over early Monday morning. (Eric M. Sheahan/Mayo Clinic via AP) less

In this June 11, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. The surgery that started shortly before midnight Friday was ... more

Photo: Eric M. Sheahan, HONS

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In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 hours to procure the donor's face, which involved taking bone, muscle, skin and nerves, and almost the same time to prepare the recipient. His entire face was rebuilt below his eyes, taking an additional 32 hours. The medical team rotated, taking four-hour breaks through the weekend. (Eric M. Sheahan/Mayo Clinic via AP) less

In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 hours to procure the donor's face, which ... more

Photo: Eric M. Sheahan, HONS

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In this June 18, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini checks on his patient, Andy Sandness, days after leading a team that performed the first face transplant surgery at the medical center. Sandness, who was sedated for several days, wasn't allowed to see himself immediately. His room mirror and cell phone were removed. (Eric M. Sheahan/Mayo Clinic via AP) less

In this June 18, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini checks on his patient, Andy Sandness, days after leading a team that performed the first face transplant surgery at the medical center. ... more

Photo: Eric M. Sheahan, HONS

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In this July 3, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini shaves the face of his patient, Andy Sandness, days after leading a team that performed the first face transplant surgery at the hospital. Over the years, the two say they've become as close as brothers. (Eric M. Sheahan/Mayo Clinic via AP) less

In this July 3, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini shaves the face of his patient, Andy Sandness, days after leading a team that performed the first face transplant surgery at the ... more

Photo: Eric M. Sheahan, HONS

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This undated photo provided by his wife, Lilly, shows Calen "Rudy" Ross. In June 2016, he died of a self-inflicted gun shot. He had designated he wanted to be an organ donor, but when the idea was brought to Lilly about a donation for a face transplant, she says, "I was skeptical at first. ... I didn't want to walk around and all of a sudden see Calen." She was reassured the donor had his own eyes and forehead and would not be recognizable as her husband. After consulting with her husbandÂs best friend, she gave her consent. (Courtesy Lilly Ross via AP) less

This undated photo provided by his wife, Lilly, shows Calen "Rudy" Ross. In June 2016, he died of a self-inflicted gun shot. He had designated he wanted to be an organ donor, but when the idea was brought to ... more

Photo: HONS

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This undated photo provided by his wife, Lilly, shows Calen "Rudy" Ross. In June 2016, he died of a self-inflicted gun shot. When agreeing to a donation for a face transplant, Lilly thought of her baby son. "The reason that I decided to ... go through with it was so that I can later down the road show Leonard what his dad had done to help somebody," she said in a video produced by LifeSource, a nonprofit group that works with families in the upper Midwest to facilitate organ and tissue donation. (Courtesy Lilly Ross via AP) less

This undated photo provided by his wife, Lilly, shows Calen "Rudy" Ross. In June 2016, he died of a self-inflicted gun shot. When agreeing to a donation for a face transplant, Lilly thought of her baby son. ... more

Photo: HONS

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﻿Andy Sandness﻿ before his injuries in 2006, left, and after his face transplant surgery.

﻿Andy Sandness﻿ before his injuries in 2006, left, and after his face transplant surgery.

Photo: HONS

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﻿Andy Sandness﻿ before his injuries in 2006, left, and after his face transplant surgery.

﻿Andy Sandness﻿ before his injuries in 2006, left, and after his face transplant surgery.

Photo: Charlie Neibergall, STF

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In this Jan. 24, 2017, photo, face transplant recipient Andy Sandness looks in a mirror during an appointment with physical therapist Helga Smars, right, at Mayo Clinic in Rochester, Minn. He wasn't allowed to see himself immediately after the surgery. His room mirror and cell phone were removed. When he finally did see his face after three weeks, he was overwhelmed. "Once you lose something that you've had forever, you know what it's like not to have it. ... And once you get a second chance to have it back, you never forget it." Just having a nose and mouth are blessings, Sandness says. "The looks are a bonus." (AP Photo/Charlie Neibergall) less

In this Jan. 24, 2017, photo, face transplant recipient Andy Sandness looks in a mirror during an appointment with physical therapist Helga Smars, right, at Mayo Clinic in Rochester, Minn. He wasn't allowed to ... more

Photo: Charlie Neibergall, STF

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In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness has his face checked during an appointment with physical therapist Helga Smars at Mayo Clinic in Rochester, Minn. Sandness, the first to receive a face transplant at the medical center, has the nose, cheeks, mouth, lips, jaw and chin of his donor. (AP Photo/Charlie Neibergall) less

In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness has his face checked during an appointment with physical therapist Helga Smars at Mayo Clinic in Rochester, Minn. Sandness, the first to ... more

Photo: Charlie Neibergall, STF

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FILE - In this Tuesday, Jan. 24, 2017 photo, face transplant recipient Andy Sandness wears a LifeSource bracelet at the Mayo Clinic in Rochester, Minn. LifeSource, a nonprofit group, works with families in the upper Midwest to facilitate organ and tissue donation. (AP Photo/Charlie Neibergall) less

FILE - In this Tuesday, Jan. 24, 2017 photo, face transplant recipient Andy Sandness wears a LifeSource bracelet at the Mayo Clinic in Rochester, Minn. LifeSource, a nonprofit group, works with families in the ... more

Photo: Charlie Neibergall, STF

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In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness talks with physical therapist Helga Smars, right, during an appointment at the Mayo Clinic in Rochester, Minn. His facial muscles are growing stronger. He received speech therapy to learn to use his tongue in a new mouth and jaw and enunciate clearly. He's thrilled to smell again, breathe normally and be eating foods that were off-limits for a decade: apples, steak and pizza that he shared with his doctors. (AP Photo/Charlie Neibergall) less

In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness talks with physical therapist Helga Smars, right, during an appointment at the Mayo Clinic in Rochester, Minn. His facial muscles are growing ... more

Photo: Charlie Neibergall, STF

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In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness is hugged by Dr. Samir Mardini, foreground, during a visit to the Saint Marys Hospital campus at the Mayo Clinic in Rochester, Minn. Mardini led a medical team to perform Sandness' face transplant surgery, the first performed at the medical center. (AP Photo/Charlie Neibergall) less

In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness is hugged by Dr. Samir Mardini, foreground, during a visit to the Saint Marys Hospital campus at the Mayo Clinic in Rochester, Minn. Mardini ... more

Photo: Charlie Neibergall, STF

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In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness walks to the Saint Marys Hospital campus at Mayo Clinic in Rochester, Min. Sandness can pinpoint the day he looked normal. About three months after the procedure, he was in an elevator with a little boy who glanced at him, then turned to his mother without appearing scared or saying anything. "I knew then," he says, "that the surgery was a success." (AP Photo/Charlie Neibergall) less

In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness walks to the Saint Marys Hospital campus at Mayo Clinic in Rochester, Min. Sandness can pinpoint the day he looked normal. About three ... more

Photo: Charlie Neibergall, STF

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CORRECTS BYLINE TO JEANNA L. DUERSCHERL - In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 hours to procure the donor's face, which involved taking bone, muscle, skin and nerves, and almost the same time to prepare the recipient. His entire face was rebuilt below his eyes, taking an additional 32 hours. The medical team rotated, taking four-hour breaks through the weekend. (Jeanna L. Duerscherl/Mayo Clinic via AP) less

CORRECTS BYLINE TO JEANNA L. DUERSCHERL - In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 ... more

Photo: Jeanna L. Duerscherl, HONS

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CORRECTS BYLINE TO JEANNA L. DUERSCHERL - In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 hours to procure the donor's face, which involved taking bone, muscle, skin and nerves, and almost the same time to prepare the recipient. His entire face was rebuilt below his eyes, taking an additional 32 hours. The medical team rotated, taking four-hour breaks through the weekend. (Jeanna L. Duerscherl/Mayo Clinic via AP) less

CORRECTS BYLINE TO JEANNA L. DUERSCHERL - In this June 13, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. It took about 24 ... more

Photo: Jeanna L. Duerscherl, HONS

Twin tragedies give survivor a new face

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ROCHESTER, Minn. - He'd been waiting for this day, and when his doctor handed him the mirror, Andy Sandness stared at his image and absorbed the enormity of the moment: He had a new face, one that had belonged to another man.

His father and his brother, joined by doctors and nurses at Mayo Clinic, watched him examine his swollen features. He was just starting to heal from one of the rarest surgeries in the world - a face transplant, the first at the medical center. He had the nose, cheeks, mouth, lips, jaw, chin, even the teeth of his donor. Resting in his hospital bed, he still couldn't speak clearly, but he had something to say.

"Far exceeded my expectations," he scrawled in a notebook.

"You don't know how happy that makes us feel," Dr. Samir Mardini replied as he read the message aloud, addressing the man who'd become his friend over the last decade.

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The exchange came near the end of an extraordinary medical journey that revolved around two outdoorsmen, both just 21 when they decided to kill themselves: Sandness survived but with a face almost destroyed by a gunshot; the other man died.

Their paths wouldn't converge for years, but when they did - in side-by-side operating rooms - one man's tragedy offered hope the other would have a second chance at a normal life.

Two days before Christmas in 2006, a deeply depressed Andy Sandness put a rifle beneath his chin and pulled the trigger.

He was rushed from his home in eastern Wyoming, treated at two hospitals, then transferred to Mayo Clinic, where he met Mardini, a plastic surgeon whose specialty is facial reconstruction.

Sandness had no nose or jaw. His mouth was shattered; just two teeth remained. He'd lost some vision in his left eye.

Mardini and his team reconstructed his upper and lower jaw with bone, muscle and skin from the hip and a leg. They reconnected facial bones with titanium plates and screws.

After about eight surgeries over 4½ months, Sandness returned to tiny Newcastle, Wyo., where friends and family embraced him. He worked at a lodge, in the oil fields and as an electrician's apprentice.

But his world had shrunk. When he went grocery shopping, he avoided eye contact with children so he wouldn't scare them. He had almost no social life. He retreated to the hills to hunt and fish.

Sandness adapted. His mouth was too small for a spoon so he tore food into bits. He wore a prosthetic nose, but it constantly fell off outdoors.

"You never fully accept it," he says. "You eventually say, 'OK, is there something else we can do?'"

The prospect of 15 more surgeries Mardini had mapped out scared him. For several years, Sandness made annual visits to Mayo.

56-hour operation

Then in 2012, Mardini called. It looked like Mayo was going to launch a face transplant program; Sandness might be an ideal patient.

Mardini urged him to "think very hard" about the transplant. Only about two dozen had been done worldwide. He wanted Sandness to understand the risks and lifelong regimen of anti-rejection drugs.

"When you look like I looked and you function like I functioned, every little bit of hope that you have, you just jump on it," he says, "and this was the surgery that was going to take me back to normal."

Last June, five months after his name was added to the waiting list of the United Network for Organ Sharing, he got word: A donor was available.

Calen "Rudy" Ross had fatally shot himself. His devastated 19-year-old widow, Lilly, was eight months pregnant. Despite her grief, she carried out her husband's wishes to be an organ donor. She met with a coordinator from LifeSource, a nonprofit group that helps families in the upper Midwest facilitate organ and tissue donation.

"I was skeptical at first," Lilly says. "I didn't want to walk around and all of a sudden see Calen." She was reassured because the donor had his own eyes and forehead and wouldn't be recognizable as her husband.

Mayo's medical team, which had rehearsed the surgery for 3½ years with cadaver heads, gathered one June night to start a 56-hour marathon.

It took about 24 hours to procure the donor's face, which involved taking bone, muscle, skin and nerves - and almost the same time to prepare Sandness. His face was rebuilt below his eyes, taking an additional 32 hours.

Having a nose and mouth are blessings, he says. "The looks are a bonus."

Sandness, now 31, is thrilled to eat steak and pizza again.

He also savors his anonymity. Recently, he attended a Minnesota Wild hockey game where, he says, he was "just another face in the crowd."